Tim, I'm responding to this line in your message: "That must be what it's like to be a PM doc except you can also make them drug addicts or worse. "
I'm not sure what you could mean by "or worse," but I do want to clarify the point about becoming addicted. There is a difference between physical addiction & physical dependence which might be to what you are referring. Physical dependence is common even with regular medications such as Benadryl for allergies for example as with Controlled drugs such as MS Contin (long acting Morphine Sulfate) or Codeine. A body will build up a resistance to a drug over time and by this I mean several years 5-10 or more even. This is normal and the dose may need adjusting upward, an additional med added if at the maximum or change for awhile & return to the drug.
Physical addiction occurs when a Narcotic is taken when there is no pain receptors for it to "work on" and instead works on the receptors that produce the effect of Euphoria, etc. that people find enjoyable & thus become addicted. Even persons with chemical addictions with Chronic Pain can be prescribed Controlled drugs because the drug will be working on the correct receptors. And, these addicts are going to be sure to use the drug correctly in order to have the pain relief they so desperately need. Most studies have been done related to Cancer Care & the Chronic Pain related to this.
My information is based on my previous career, Long Term Care Nurse (RN) including care of Cancer pts, research done /family members with cancer & my own Chronic Persistent Unremitting Pain, and Fibromyalgia & Migraines with no aura to name a few since 2002 (Actual year of unset same as year of diagnosis). I am seen by a specialty trained Nurse Practitioner at a Pain Management & Rehab clinic owned/run by a Physiatrist. MS Contin is not my only pain relief treatment but the main one & I have actually decreased my dosage over time.